Crew Chief Class

1. Crew Chief Class

2. The Crew Chief Class • Introduction to the Position • Rules & Responsibilities • Duties of the Crew Chief • “Good Clinical Judgment” • Useful Information • PCR Writing & Documentation • Written Examination & Procedures for Advancement

3. Introduction to the Position

4. Who or What is a Crew Chief? • The person in charge of a crew • “Leader” of the Crew • “Procedurally In-Charge” • In charge of all patient care given • Is at least a NY State EMT-B (Can be an AEMT I, CC, or P) • Ensures crew follows all Agency Procedure and Protocols

5. Rules & Responsibilities

6. Rules • RPI Ambulance Standard Operating Procedures (SOPs) • 04-04 & 04-07 Describe the Position • 04-05 Describe the Training Process • NY State Department of Health • Public Health Law Article 30 • Defines the Emergency Medical Service System & Other Associated Requirements • 10 NYCRR Part 800 • More Laws Governing EMS & Ambulance Operations • 10 NYCRR Part 18 • Law About Public Functions and EMS • US Government • Health Insurance Portability and Accountability Act (HIPAA) • The Privacy Law!

7. Rules: Where can I find them? • RPI Ambulance Standard Operating Procedures (SOPs) • http://ambulance.union.rpi.edu/SOPs2004.doc • NY State Department of Health • Public Health Law Article 30 • http://www.health.state.ny.us/nysdoh/ems/art30.htm • 10 NYCRR Part 800 • http://www.health.state.ny.us/nysdoh/ems/part800.htm • 10 NYCRR Part 18 • http://www.health.state.ny.us/nysdoh/ems/part18.htm • US Government • HIPAA • http://www.hhs.gov/ocr/hipaa/

8. Rules: When Can I start Crew Chief Training? “Any individual who acts in the capacity of Crew Chief must be properly credentialed as an R.P.I. Ambulance Crew Chief or must be a valid Crew Chief Trainee with a Crew Chief Trainer present. As such, any person acting as the Crew Chief must meet the qualifications as set forth in Policy # 04-05.” • Hold a valid NYS EMT-B certification • Be an Attendant • Attend and pass the written exam for the RPI Ambulance Crew Chief Training Class

9. Responsibilities • You’re In Charge • Of the Crew • Patient Care rendered by you & your Crew! • Crew Morale • All Appropriate Documentation (Patient Care Reports (PCRs), Incident Reports, Training Evaluations, etc)

10. Responsibilities “The position of Ambulance Crew Chief is the highest credentialed position in the Ambulance Crew. Becoming an Ambulance Crew Chief involves not only medical proficiency, but also thorough knowledge of all Operating Policies and an ability to lead the crew effectively. The Crew Chief Trainee should, while training, act in the capacity of Crew Chief to the best of his or her ability. The training period is a time to gain experience with a trained Crew Chief on board. The Crew Chief Trainee is encouraged to attend as many drills as possible as they are a good source of knowledge and training.”

11. Duties of the Crew Chief

12. Duties During a Crew • Completion of an Ambulance Equipment Checklist • Reporting any discrepancies or problems to the Duty Supervisor • Try to fill any vacancies on the crew • Provide training opportunities if time allows • Maintain Crew Morale • Remember you’re a student first

13. Duties During a Call • Confirm Crew and try to include trainees • Advise Driver of appropriate level of response (Priority I or II) • Plan usage or resources and equipment en route • All radio communications • Scene Safety • In charge of Patient Care Given and ensure Patient receives appropriate care (BLS Transport, ALS, Helicopter, etc)

14. Duties During a Call (continued) • Allowing other members to train as appropriate • Make appropriate Hospital Destination Choice • En Route to Hospital give report over VHF radio • Transfer patient to receiving medical facility with report • Complete paperwork and verify ambulance is ready for the next call • Go back in service as quickly as possible

15. “Good Clinical Judgment”

16. New York State BLS Protocols “These protocols are not intended to be absolute and ultimate treatment doctrines, but rather standards which are flexible to accommodate the complexity of the problems in patient management presented to Emergency Medical Technicians (EMTs) and Advanced Emergency Medical Technicians (AEMTs) in the field. These protocols should be considered as a model or standard by which all patients should be treated. Since patients do not always fit into a "cook book" approach, these protocols are not a substitute for GOOD CLINICAL JUDGMENT, especially when a situation occurs which does not fit these standards.“

17. Review of a Few Protocols • “Adult Major Trauma” • Mechanisms of Injury • 1. Ejection or partial ejection from an automobile • 2. Death in the same passenger compartment • 3. Extrication time in excess of 20 minutes • 4. Vehicle collision resulting in 12 inches of intrusion in to the passenger compartment • 5. Motorcycle crash >20 MPH or with separation of rider from motorcycle • 6. Falls from greater than 20 feet • 7. Vehicle rollover (90 degree vehicle rotation or more) with unrestrained passenger • 8. Vehicle vs pedestrian or bicycle collision above 5 MPH

18. Review of a Few Protocols • “Adult Major Trauma” (continued) • Physical Findings • 1. Glasgow Coma Scale is less than or equal to 13 • 2. Respiratory rate is less than 10 or more than 29 breaths per minute • 3. Pulse rate is less than 50 or more than 120 beats per minute • 4. Systolic blood pressure is less than 90 mmHg • 5. Penetrating injuries to head, neck, torso or proximal extremities • 6. Two or more suspected proximal long bone fractures • 7. Suspected flail chest • 8. Suspected spinal cord injury or limb paralysis • 9. Amputation (except digits) • 10. Suspected pelvic fracture • 11. Open or depressed skull fracture

19. Review of a Few Protocols • “Adult Major Trauma” (continued) • “High Risk Patients • 1. Bleeding disorders or patients who are on anticoagulant medications • 2. Cardiac disease and/or respiratory disease • 3. Insulin dependent diabetes, cirrhosis, or morbid obesity • 4. Immunosuppressed patients (HIV disease, transplant patients and patients on • chemotherapy treatment) • 5. Age >55 • Treatments? • ABC’s, Immobilization, Oxygen, Request ALS, Transport Rapidly to Trauma Center

20. Review of a Few Protocols • “Suspected Stroke (CVA)” • ABC’s, Oxygen, History of Present Illness, Cincinnati Prehospital Stroke Scale • Transportation Decision? • Go to Stroke Center if the total prehospital time (time from when the patient’s symptoms and/or signs first began to when the patient is expected to arrive at the Stroke Center) is less than two (2) hours.

21. Review of a Few Protocols • “Altered Mental Status” • Scene Safety, ABC’s, Oxygen, Level of Consciousness, Request ALS, History of Present Illness • Treatments of Known Conditions such as Diabetes • These were only 3 of the NYS BLS Protocols! You need to know your protocols well, you should have received them in EMT Class. Now is the time to make sure you know them backwards and Forwards!!!

22. The Area Hospitals • Samaritan Hospital 2215 Burdett Ave Troy, NY • Stroke Center ~4 Minutes • Saint Mary's Hospital 1300 Massachusetts Ave Troy, NY • ~5 Minutes • Albany Medical Center 43 New Scottland Ave Albany, NY • Trauma, Stroke Center, Cath. Lab ~15 Minutes • Saint Peter’s Hospital 315 S. Manning Blvd Albany, NY • Cath. Lab ~20 Minutes • RPI Student health Center Academy Hall RPI Campus

23. The Area Hospitals (The Rarer Ones) • Albany Memorial 600 Northern Blvd Albany, NY • ~15 Minutes • Albany VA Stratton 113 Holland Ave Albany, NY • VA: Veterans ~15 Minutes • Ellis Hospital 1101 Nott St. Schenectady, NY • Stroke Center ~30 Minutes • Saint Claire’s Hospital 600 McClellan St. Sch’dy, NY • ~30 Minutes • Bellevue Maternity Hospital 2210 Troy-Sch’dy Road Niskayuna, NY • OB/GYN ~20 Minutes

24. Useful Information

25. Radio Communications: Determinants • Alpha: BLS Priority II • Bravo: BLS Priority I • Charlie: ALS & BLS Priority I • Delta: ALS & BLS Priority I • Echo: Cardiac or Respiratory Arrest ALS & BLS Priority I (anyone with an AED)

26. Radio Communications: The dispatch • RPI Ambulance is dispatched on Channel 1 on RPI Ambulance’s Radios: • Dispatcher: “Stand By RPI Ambulance” • Tones • Dispatcher: “Stand By RPI Ambulance for a <determinant> determinant EMS call for <Demographics> <Chief Complaint> at <Location>” • Example: “Stand By RPI Ambulance for a bravo determinant EMS call for a 18 year old male patient with a Laceration at the RPI Houston Field House”

27. Radio Communications • “800 Mhz” • Radioing Dispatch. Call sign 5959 • Acknowledging Call, Confirming Crew • En route to scene • on scene • En route to hospital • Arrive at hospital • In service • In Quarters • Portables (HT750 155.220) • Amassing Crew and Communication during operations. Call sign RPI Ambulance Car xx

28. Advanced Life Support (ALS) • How do I Get it? • Radio Dispatch. • Who do I get it from? • Troy Fire Department • Mohawk Ambulance • Empire Ambulance • North Greenbush Ambulance • Meeting up with ALS • Choices: Await ALS Intercept or ALS on Scene?

29. Mutual Aid • What is it? • Who may call us for it? • City of Troy • North Greenbush • Poestenkill • Brunswick • Who do we call for it? • Troy Fire Department • Mohawk Ambulance • Empire Ambulance

30. Other Circumstances • Equipment Failure • Child or Elder Abuse • Hospital Diversion • Field House Operations • MCI Protocols • Contacting medical control • RMA’s • Rights, Clinical Findings, and Possible Consequences up to and including death. • Signature of Patient or Patient’s Guardian and a Witness are required. • Completion of a REMO RMA Checklist

31. Hospital Radio Reports • Needs the following Information • Patient’s Age and Gender • Estimated Time to Arrival (ETA) • Chief Complaint and History of Present Condition • Pertinent Past Medical History • Treatments and Vital Signs • “Do you Require anything further?”

32. Hospital Radio Reports • Example: • “Samaritan Hospital, RPI Ambulance. Currently en route to your facility with an 18 years old male patient with a 5 minute ETA. Patient twisted his knee earlier this evening playing soccer. Knee is immobilized, cold applied, on oxygen. Vital signs within normal limits and the patient is resting comfortably, do you require anything further?” • Example: • “Albany Medical Center, RPI Ambulance. Currently en route to your facility with a 25 years old male patient with a 15 minute ETA. Patient involved in a head on motor vehicle accident, approximate speed 30 mph and struck a tree. Pt is complaining of severe abdominal pain and tenderness in the Upper Quadrants. Patient is immobilized and on oxygen. Vital signs as follows BP102/70, Pulse 124 sinus tachycardia on monitor, Respirations 26, spO2= 93% on Oxygen, Pupils PEARRL. Troy Fire ALS on board, Patient is IV positive with two large bore IVs. do you require anything further?”

33. PCR Writing & Documentation

34. The PCR • What is it? • A complete written record of your Patient Assessment, care given, and Transporting of the Patient to the hospital • It is a Legal Document! • It is a triplicate form with one copy being left with each of the following organizations • Receiving Hospital • Agency • REMO or the State

39. 1 0 12 05 0 8 13 33 4130 5939 RPI Ambulance 1400 1403 1406 1424 1427 1445 1445 1.0 0.0 Traumatic Injury RPI Harkness Field 4102 1.0 JOHN DOE 123 Fake Street 518 123 4567 • • B TROY NY 12180 19 09 17 1986 000 00 0000 •

40. RPI DPS, TFD E2 L. Lawrence, MD • • HT • Twist • • • • • • ASA 1410 22 80 130 90 • • 4 5 6/15 • • • • • • • • • 1420 20 84 132 P • 4 5 6/15 • • • • Albuterol • • • 1425 22 80 124 P 4 5 6/15 • • • • •

41. • • • • • PtA, V/S, LS, spO2 SAMARITAN HOSPITAL BED 8 4 1 2 Crew Chief Driver Attendant Observer • • 3 0 0 0 0 0 3 3 3 3 3 3 O B S O B S

42. Chief Complaint and Narrative • Chief Complaint: I twisted my knee playing soccer • Narrative: U/A 19 y/o ♂ found lying supine on the ground I/C/O RPI DPS and TFD E2 c/o while playing soccer and running and feeling his R knee pop. Pt is complaining of 5/10 pain from the incident that happened approximately 15 min /a to EMS arrival. + Patent, self- maintained airway. Breathing 22/min /s labor /c +, = chest rise and fall LS clear = , bilateral –SOB, diff breathing, JVD, tracheal deviation. spO2=98% RA. Pt put on O2 via NRB @ 12 LPM ↑ spO2=100%. Circulation 80/min strong and regular BP= 130/90 skin warm and dry. –Gross Bleeding, Obvious Deformities –CP, N/V/D, dizziness, lightheadedness, headache +CSMx4. Pt AOx3 /c GCS= 15 (4,5,6). Upon P/E R knee swollen in comparison to L, R leg immobilized /c CSM in R leg /a & /p splinting. Ice pack applied to R knee. P/E otherwise unremarkable and within normal limits. Pt transported to 412 ED /s incident /c ↓ in pain to 3/10. Pt transferred to Bed 8 and left I/C/O RN /c rails up x2, report, and in possession of belongings.

43. REMO Approved Abbreviations • Available online http://www.remo-Ems.com/abbrev4.pdf The Most Important Ones! c/o: complaining of /c: with ♀: female /s: without ♂: Male /A: before CP: chest pain /p: After SOB: Shortness of Breath TXF: Transferred ABD: Abdomen TXP : Transported N/V/D: Nausea, Vomiting, Diarrhea TOT: Turned over to LS: Lung Sounds VS: Vital Signs CSMx4: Circulation, Sensation, Motor x4 Pt : Patient P/E: Physical Exam HTN: Hypertension spO2: Pulse Oximetry LOC: Loss of Consciousness U/A: Upon Arrival Y/O: Years Old AOx3: Alert & Oriented x3 JVD: Jugular Vein Distension I/C/O: In Care of Δ: Changes

44. Written Examination & Procedures for Advancement

45. The Requirements • Backup Crew Chief • A. Hold a valid NYS EMT-B certification or higher • B. Be an Attendant • C. Attend and pass the written exam for the RPI Ambulance Crew Chief Training Class • D. Complete the Crew Chief Checklist • E. After completing requirements A, B and C pass a Crew Chief Practical Exam including Radio Report and PCR as set up by the Training Lt. • F. Tek 2 calls with a Crew Chief Trainer in the patient care compartment of the Ambulance and submit Crew Chief Evaluation Forms • G. Request and receive approval by the Captain and Training Lt. to be promoted to Backup Crew Chief

46. The Requirements • Crew Chief • A. Be a Backup Crew Chief • B. Tek 1 call as a Backup Crew Chief and submit a Crew Chief Evaluation Form • C. Student Teach 1 Training Drill and submit Training Drill Instructor Evaluation Form • D. Request and receive approval by a Promotional Board as defined in SOPs to be promoted to Crew Chief

47. The Crew Chief Trainers • Warren Hayashi, AEMT-CC • Anthony Richard, EMT-B, CC Student • Eric Tesoriero, EMT-B, CC Student • Sarah Toner, EMT-B

48. Test Time

49. The End. Go Out and Tek Some EMS Calls